A 33-year experience with surgical management of popliteal artery aneurysms

Abstract

Objective: This study retrospectively analyzed our 33-year experience with surgical management of popliteal artery aneurysms (PAAs), with particular attention paid to early and long-term results.

Methods: From January 1981 to December 2013, 234 open surgical interventions for PAA were performed in 196 patients. Data concerning these interventions were collected in a dedicated database containing main preoperative, intraoperative, and postoperative features. Early (intraoperative and <30 days) results were analyzed for mortality, thrombosis, reintervention, and amputation rates. The follow-up program consisted of clinical and duplex ultrasound examinations at 1 month and yearly thereafter. Patients who did not accomplish follow-up examinations were interviewed by telephone. Additional data regarding long-term survival and major clinical events were obtained from the Regional Health Care database. Follow-up results were analyzed for survival, primary and secondary patency, and amputations rates.

Results: Patients were predominantly males (186 [95%]), with a mean age of 68.5 ± 9.9 years. The PAA was asymptomatic in 97 limbs, intermittent claudication was present in 68, and limb-threatening ischemia was present in 62. Aneurysmal rupture occurred in six patients, and venous compression with leg swelling and pain was present in one patient. The intervention consisted of aneurysmal ligation and bypass grafting in 122 interventions, aneurysmectomy with graft interposition was used in 108, and four patients underwent aneurysmectomy with an end-to-end anastomosis. An autologous vein was used in 49 interventions, and a prosthetic graft was used in 181. In 71 interventions a posterior approach was used, and in the remaining 163, a medial approach was preferred. There were two perioperative deaths, with a cumulative mortality rate of 1%. Perioperative thrombosis occurred after 18 interventions (7.7%). A successful reintervention was performed in 10 of those patients, whereas surgical thrombectomy was ineffective in one patient and leg amputation was necessary. The remaining seven patients underwent major amputation without any new surgical attempt. An adjunctive major amputation was necessary in a patient with a patent bypass for irreversible foot ischemia. The cumulative rate of amputations at 30 days was 3.8% (9 of 234 limbs). Mean duration of follow-up was 62 months (range 1-312 months). During follow-up, 31 deaths, 45 thromboses, and 10 amputations were recorded. The estimated 13-year survival rate was 50.8% (standard error [SE], 0.07%); during the same interval, primary patency, secondary patency, and limb preservation rates were 55.1% (SE, 0.05%), 68% (SE, 0.05%), and 86% (SE, 0.04%).

Conclusions: Open surgical repair of PAAs provided good results in our experience, with low rates of perioperative complications and an excellent durability in the very long-term setting, representing the benchmark for alternative techniques such as endovascular repair.